Ask The Pharmacist

Question: The doctor prescribed cholesterol medication recently. Will I need to stay on it forever?

Answer: The short answer is probably yes. Most of the time when these medications are prescribed, it is assumed that the patient will need it for the long term, not just to lower cholesterol, but to decrease the inflammation that is associated with cholesterol plaques because these problems don’t tend to stay away after a certain amount of time on treatment.

Raenel E. Mathews, PharmD

In November of last year, the American College of Cardiology and the American Heart Association came out with new guidelines specifying who should be taking cholesterol-lowering medications. The guideline focused on the “statin” type of medication and generally did not recommend the use of other types (ie, niacin, fibrates). The statins are used to lower the overall risk of what is termed atherosclerotic cardiovascular disease, or ASCVD for short. This is what we commonly refer to as “hardening of the arteries.” Artery walls get thicker because of the buildup of calcium, cholesterol and triglycerides along with inflammatory components. There are many ways ASCVD can show itself but they include: heart attack, stroke, angina, transient ischemic attacks (TIAs or “mini-strokes”), and any procedure that has been done to open up a blocked artery (stent placement, balloon angioplasty).

The new guidelines outline four groups of patients that can benefit from taking statin medications. Group 1 includes patients 75 years old and younger who already have ASCVD. Group 2 includes patients who are at least 21 years old with an LDL (“bad cholesterol”) of 190 or more (but no outright ASCVD). These two groups, according to the ACC and AHA should be given what they term “high-intensity” statin therapy. The two medications that are on this list are atorvastatin 40 or 80mg, and rosuvastatin 20 to 40mg.

Group 3 includes patients who are 40-75 years old and have diabetes along with an LDL of 70-189. Group 4 are those patients with an LDL of 70-189 but no diabetes or other overt signs of ASCVD, but they have a 10-year risk of developing some sort of ASCVD of at least 7.5 percent (your medical provider can calculate this risk). Group 3 and 4 patients are to receive “moderate-intensity” statin therapy to hopefully prevent a first ASCVD event. There are many regimens that are available in this category: atorvastatin 10 to 20mg, rosuvastatin 5 to 10mg, simvastatin 20 to 40mg, pravastatin 40 to 80mg, lovastatin 40mg, fluvastatin 80mg, and pitavastatin 2 to 4mg.

Some things to keep in mind while taking a statin: if you develop severe muscle pain (where it is painful even to have your clothing rub across your muscles) you should contact your medical provider immediately as this may be a sign that your body is not handling the medication properly. This doesn’t necessarily mean that you can’t take ANY of the statins after you have recovered. Your provider may try you on a different statin at a different dose. Also, if you notice extreme fatigue or weakness, dark urine, decreased appetite, or a yellow tint to your eyes or skin, you should notify your provider immediately as these can be signs of liver injury. These reactions do not happen often, but they need to be addressed if they occur.

Also, if you like grapefruit juice, stay away from atorvastatin, simvastatin or lovastatin and use one of the other choices. Grapefruit juice has a chemical that keeps your liver from metabolizing the drug and can lead to drug levels that are too high.

Keep in mind that taking a statin doesn’t give you a green light to eat whatever you want. You should still try to follow a diet that is low in saturated fats and mostly avoids processed foods that are high in simple carbohydrates. Saturated fats and a diet high in simple carbohydrates can continue to in­crease the “bad” components of your lipid panel, causing new plaques to form or established plaques to grow larger.